The Annals of thoracic surgery
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Rupture of the heart is usually a fatal injury in patients sustaining blunt trauma. Those arriving in the emergency department alive can be saved with prompt diagnosis and treatment. ⋯ Rarely are patients with rupture of the free cardiac wall seen in an emergency department. The improvements in the prehospital care and the transportation may result in an increase in the numbers of such patients. Physicians treating patients with blunt trauma must suspect the presence of cardiac rupture. Immediate use of ultrasonography will establish the diagnosis and prompt repair of the injury may improve overall survival.
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Large-volume hemoptysis during cardiopulmonary bypass is an infrequent, but life-threatening event. Rapid airway clearance and control are the primary prerequisites for successful management. ⋯ Major hemoptysis during cardiopulmonary bypass is best dealt with initially by rapid airway control and cessation of bypass in an expeditious manner. An algorithm for suggested management is provided. The rigid bronchoscope is the optimal tool for initial management and it should always be available. Definitive treatment is determined by the cause and the persistence of hemorrhage once these maneuvers have been performed.
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There is evidence that lung ischemia reperfusion injury is a result of the activation of components of the inflammatory cascade. However, the role of neutrophils in lung reperfusion injury continues to be a source of controversy. ⋯ Leukocyte depletion of the blood reperfusate protects against microvascular permeability and significantly improves pulmonary graft function. The neutrophil plays a major role in amplifying lung injury later during reperfusion, and this lung ischemia reperfusion injury may be reversed through the interruption of the inflammatory cascade and the interference with neutrophil infiltration.
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Although some pediatric cardiology departments have a policy of adopting primary correction of tetralogy of Fallot in all symptomatic infants, we and others still palliate neonates and infants. Effective palliation should ameliorate symptoms and allow growth of the pulmonary arteries. Although studies on the growth of the ipsilateral and contralateral pulmonary arteries after a classic Blalock-Taussig shunt have been reported, pulmonary artery growth after a modified Blalock-Taussig shunt has not been studied as thoroughly. Therefore, we examined whether there is equal growth of the contralateral pulmonary artery after a modified Blalock-Taussig shunt. ⋯ We showed equal growth of the right and left pulmonary arteries with no distortion after a modified Blalock-Taussig shunt. If palliation is considered, the modified Blalock-Taussig shunt remains our choice.
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Cardiac operations are occasionally required during pregnancy. Despite a low maternal mortality, fetal mortality remains high. ⋯ Recent experimental data suggest pulsatile perfusion may help preserve placental hemodynamic function. The successful use of pulsatile bypass to replace the aortic valve in a 25-year-old female at 14 weeks gestation, with both maternal and fetal survival, is presented.